MEDICARE: DR. YAFFA YUSUPOV PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	059742	NY

General Provider Information

NPI Number	:	1912301862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YAFFA YUSUPOV PHARM.D.

Provider Business Mailing Address
First Line	:	9708 METROPOLITAN AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6626
Country	:	US
Telephone Number	:	646-535-5915
Fax Number	:	718-744-9702

Provider Business Practice Location Address
First Line	:	9708 METROPOLITAN AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6626
Country	:	US
Telephone Number	:	646-535-5915
Fax Number	:	718-744-9702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2014
Last Update Date	:	04/25/2021

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